Dödligt virus från Kina orsakar panik (SARS-CoV-2, COVID-19)

Folkhälsomyndigheten rekommenderar att du som är vuxen och har symtom på covid-19 testar dig för att se om du har sjukdomen.

To the Editor — The global demand for prophylactic and treatment options for COVID-19 has in turn created a demand for both randomized clinical trials, and the synthesis of those trials into meta-analyses by systematic review. This process has been fraught, and has demonstrated the inherent risks in current approaches and accepted standards of quantitative evidence synthesis when dealing with high volumes of recent, often unpublished trial data of variable quality.

Research into the use of ivermectin (a drug that has an established safety and efficacy record in many parasitic diseases) for the treatment and/or prophylaxis of COVID-19 has illustrated this problem well. Recently, we described flaws in one randomized control trial of ivermectin1, the results of which represented more than 10% of the overall effect in at least two major meta-analyses2,3. We described several irregularities in the data that could not be consistent with them being experimentally derived4. That study has now been withdrawn by the preprint server5 on which it was hosted. We also raised concerns about unexpected stratification across baseline variables in another randomized controlled trial for ivermectin6, which were highly suggestive of randomization failure. We have requested data from the authors but, as of 6 September 2021, have not yet received a response. This second ivermectin study has now been published6, and there is still no response from the authors in a request for data.
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We recognize that this is a change to long-accepted practice and is substantially more rigorous than the standards that are typically currently applied, but we believe that what has happened in the case of ivermectin justifies our proposal: a poorly scrutinized evidence base supported the administration of millions of doses of a potentially ineffective drug globally, and yet when this evidence was subjected to a very basic numerical scrutiny it collapsed in a matter of weeks. This research has created undue confidence in the use of ivermectin as a prophylactic or treatment for COVID-19, has usurped other research agendas, and probably resulted in inappropriate treatment or substandard care of patients.

We recognize that by recommending IPD review by default for meta-analysis of potential therapeutic agents in COVID-19 we are calling for change to nearly universally accepted practice over many decades, but the consequent potential for patient harm on a global scale demands nothing less.

Vid resor och tillfällig vistelse på annan ort
Du bör resa på ett sätt som minimerar risken för smitta. Det kan innebära att du:

på förhand undersöker vilka regler och rekommendationer som gäller på ditt resmål
håller avstånd och helst träffas utomhus om du träffar nya människor på resmålet
inte reser alls om du har symtom som kan bero på covid-19
kan säkerställa att du kan isolera dig på ditt resmål eller ta dig hem på ett smittsäkert sätt (så att du inte smittar andra) om du utvecklar symtom på covid-19.